Hepatosplenic cat scratch disease: The usefulness of liver biopsy
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LETTER
Hepatosplenic cat scratch disease: The usefulness of liver biopsy George Patavoukas 1 & Michael Samarkos 1 & Andreas Mavroudis 1 & Dimitra Kavvouri 1 & Eleutheria Lakiotaki 2 & Stratigoula Sakellariou 2 & Chrisovalantis Vergadis 3 & Evangelos Cholongitas 1 Received: 13 August 2020 / Accepted: 28 October 2020 # Indian Society of Gastroenterology 2020
Dear Editor A 70-year-old woman presented at our Department with fever up to 38°C during the last 3 weeks accompanied by fatigue, anorexia, and loss of weight. The patient had previously visited another hospital and magnetic resonance imaging (MRI) of the abdomen had revealed the presence of multiple nodular lesions in the liver (up to 2.5 cm in diameter with contrast enhancement) and spleen (maximum diameter 8 mm) compatible with lymphoma or metastatic lesions (Fig. 1). The patient was admitted at our department for further evaluation. Her medical history was unremarkable and no travel abroad was reported. She had two cats, but she reported no scratches and bites. On admission, she was febrile and clinical examination was unremarkable without peripheral lymphadenopathy, except for the loss of weight and diffuse mild abdominal pain. Laboratory tests showed mild normochromicnormocytic anemia (hemoglobin: 9.8 g/dL), normal white blood cell count of 8600/μL (neutrophils: 6500/μL), and elevated inflammatory markers: erythrocyte sedimentation rate (ESR): 84 mm/1st hour, Creactive protein (CRP): 170 mg/L (upper limit of normal [ULN]: 5 mg/L). Cholestatic liver enzymes were slightly raised: alkaline phosphatase 168 U/L (ULN 140 U/L) and gamma-glutamyl transferase (γ-GT) 159 U/L (ULN 48 U/L), while aspartate aminotransferase * Evangelos Cholongitas [email protected] 1
First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Agiou Thoma 17, 11527 Athens, Greece
2
Department of Pathology, Medical School of National and Kapodistrian University of Athens, Athens, Greece
3
Department of Interventional Radiology, Laiko General Hospital, Athens, Greece
(AST)/alanine aminotransferase (ALT), bilirubin, and lactate dehydrogenase (LDH) were within normal ranges. Multiple blood cultures were sterile. Serology for human immunodeficiency virus (HIV), hepatitis B and C, Epstein-Barr virus, cytomegalovirus, and Coxiella burnetii was all negative. Transthoracic and transesophageal echocardiogram revealed normal valves with no vegetations. A computed tomography (CT)-guided biopsy of a liver lesion revealed granulomatous inflammation with central necrosis and accumulation of neutrophils, leading to an abscess formation. Palisading histiocytes accompanied by lymphocytes surrounded the abscess periphery (Fig. 2a–d). Ziehl-Neelsen and PeriodicAcid Schiff (PAS) histochemical stains were negative for acid-fast bacilli and fungi, respectively. Further evaluation of liver granulomatous disease was performed. Mantoux test, quantiferon, and gastric aspirate polymerise chain reaction (PCR) for Mycobacterium tuberculos
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